Posterior scleritis presenting as conjunctivitis in a child

Area of Science:

• Ophthalmology
• Rheumatology

Background:

• Posterior scleritis is an uncommon inflammatory condition affecting the posterior part of the eye.
• It can present with varied symptoms, often mimicking other ocular pathologies, leading to diagnostic challenges.

Observation:

• A 14-year-old male presented with unilateral eye redness and decreased vision, initially diagnosed as viral conjunctivitis.
• Clinical examination revealed conjunctival congestion, disc hyperemia, and retinal striae.
• Ocular imaging demonstrated peripapillary serous macular detachment and characteristic 'T' sign with scleral thickening.

Findings:

• Bilateral posterior scleritis was diagnosed based on clinical and imaging findings.
• The patient showed significant improvement in visual acuity and resolution of macular detachment and retinal striae after treatment.

Implications:

• This case highlights the importance of considering posterior scleritis in the differential diagnosis of acute visual disturbances, even in young patients.
• Early diagnosis and appropriate treatment, including topical steroids and oral NSAIDs, are crucial for favorable visual outcomes in posterior scleritis.